Friday, February 13, 2015

Is the freezer really women’s liberator? Part II: The cold truth: Egg freezing may not be all it is cracked up to be.

In my last post I talked about the buzz that egg freezing is getting lately. Part of the reason for the press attention is that in January 2013 the American Society for Reproductive Medicine (ASRM) and the Society for Assisted Reproductive Technology (SART) lifted the experimental label they had placed on egg freezing (oocyte cryopreservation) just five years earlier. While sperm and embryos (fertilized eggs) have been successfully frozen for decades, egg freezing has long been problematic. Using the traditional slow freezing technique, ice crystals form during the freezing process which can rupture the cell membrane and cause cellular destruction. However, the development of vitrification, a flash-freezing process using cyroprotectants, has significantly improved survival rates for frozen eggs.

While science has advanced the ability to preserve an egg, the process of extracting them from a women’s body is still difficult. The process of egg-freezing requires women to go through the same initial procedures used to harvest eggs for IVF. A woman must inject herself with follicle stimulating hormones (FSH) on a daily basis for a period of approximately two to three weeks to hyperstimulate her ovaries to produce multiple ova. Then the woman is placed under IV sedation, and a reproductive endocrinologist uses a needle to extract the eggs from the ovaries.

This is an invasive process. The side effects of the drugs administered during the egg retrieval process include headache, fatigue and bloating. They are also associated with a serious, although rare, condition called ovarian hyperstimulation syndrome (OHSS). Many of these medications have never been tested and approved by the FDA for this type of fertility use, leading many critics of IVF to argue that more research is needed to determine whether such hormones injections are safe for women.

Egg freezing was originally developed to preserve fertility in cancer patients. For women of reproductive age facing cancer treatment who do not have the option of freezing embryos, egg freezing can preserve their ability to carry a genetically related child in the future. The type of egg freezing is done out of medical necessity and is referred to as medical egg freezing.

Egg freezing has become more widely used though. The potential for deferred child-bearing is alluring and women without medical need are now using it to avoid future infertility at a later age, a term called “social egg freezing.” Crucially though, the newly released ASRM and SART guidelines explicitly state that while the technology may appear to be an attract strategy for women to have biologic children later in life,

Marketing [egg-freezing] technology for the purpose of deferring childbearing may give women false hope. There are not yet sufficient data to recommend oocyte cryopreservation for the sole purpose of circumventing reproductive aging in healthy women because there is no data to support the safety, efficacy, ethics, emotional risks, and cost-effectiveness of oocyte cryopreservation for this indication. In addition, while the data are reassuring at this point, it is too soon to conclude that the incidence of anomalies and developmental abnormalities of children born from cryopreserved oocytes is similar to those born from cryopreserved embryos… More data are needed before this technology should be used routinely.

There are multiple reasons why egg-freezing for social reasons is problematic. First off, the statistics are not promising. According to author Miriam Zoll,

The most comprehensive data available reveals a 77 percent failure rate of frozen eggs resulting in a live birth in women aged 30, and a 91 percent failure rate in women aged 40. For a 38 year old woman, the chance of one frozen egg leading to a live birth is only 2 to 12 percent.

Another major concern with egg freezing is that the Assisted Reproductive Technology (ART) field, of which egg freezing is a part of, is not well regulated. The Centers of Disease Control (CDC) publish statistics that ART clinics voluntary provide, but otherwise the industry is self-policed. As a result of this lax regulatory structure, there can be considerable variance in the type and extent of information given to patients when they go an ART clinic. As Seema Mohapatra points out in her article for the Harvard Law & Policy Review, this creates a problem with informed consent for patients seeking social egg freezing. When a woman undergoes egg freezing she may be giving up her opportunity to have a child without medical intervention. Therefore, it is crucial that she be made aware of the risks and likelihood of success. The problem with egg freezing is that much of this information is unknown. Thus, to ensure true informed consent is given, a comprehensive list of the unknowns should be provided to women undergoing social egg freezing. Currently there is no such policy.

Finally, there is the issue of cost. The costs involved with social egg freezing makes the procedure unobtainable for most women. The initial egg retrieval procedure itself can cost between $5,000 and $20,000 per cycle. It is recommended that a woman freeze between ten and twenty-five eggs to provide a chance at pregnancy later. Therefore, depending on the women’s situation, she may need or wish to repeat the procedure multiple times. On top of this cost, there is a fee for yearly storage of the eggs. Currently the fee is approximately $500 - $800 per year. Finally, once the woman is ready to thaw and use the frozen eggs, there are additional costs associated with the IVF procedure required to have the eggs implanted. Altogether, it is estimated to cost an average of $40,000 to have your eggs frozen, stored, and then later implanted.